Provider Demographics
NPI:1043362007
Name:DENESSEN, MARLENE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:
Last Name:DENESSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1136
Mailing Address - Street 2:
Mailing Address - City:SOUTH WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02663
Mailing Address - Country:US
Mailing Address - Phone:508-896-7790
Mailing Address - Fax:
Practice Address - Street 1:715 OLD KINGS HIGHWAY
Practice Address - Street 2:
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667
Practice Address - Country:US
Practice Address - Phone:508-896-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3294103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6106386OtherUNITED BEH HEALTH
004128OtherHARVARD PILGRIM
6106386OtherUNITED BEH HEALTH